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>Dr Perry, I've been thinking about asking you for a >while and I figured it's about time I expanded on my >inquiry. > >I'm curious about your position from the perspective >of a medical professional on whether you would prefer >kids who show up at your office to be in diapers? I'm >not talking about toddlers but older kids. I've talked >to a few doctors who admit that they prefer the >children to be in diapers just because there's a >propensity for accidents and kids get very nervous at >the doctor anyway, especially if they're going to get >a shot. But I'm curious if you would also, from your >personal perspective, prefer the children to be >plugged so that there aren't any bowel accidents. You >could remove the plug yourself if you needed a stool >sample. Do you agree? And do you think it would be >appropriate for other medical situations, like for >dental or orthodontist procedures - especially if the >children are going to be restrained? And finally, what >is your opinion about children under DD having their >hands restrained from time to time? > > >>As a doctor, I have dealt long and extensively with >>the topic of diaper discipline. Personally, I find >>this form of education extremely helpful and support >>it without any reservation. That's why I always try to >>support interested parents with advice and support. >>I've been following this forum for some time and there >>seems to be a lively exchange here that I would like >>to take part in. >>I would like to make a few comments on the question of >>how older children in particular can be put back into >>diapers without major problems. >> >>In my opinion, diaper discipline and voluntary >>incontinence are inseparably linked in older children. >>However, one should be aware that artificially induced >>incontinence is always a long-term decision. >>A week or even just a weekend or something like that >>isn't possible. Such a decision must always be made >>for at least 3 months. >> >>Perhaps I should briefly explain the urethral tract to >>avoid misunderstandings. >>The bladder itself is a muscle, at the end of the >>bladder there is a sphincter that is controlled >>separately. >>When you need to urinate, the sphincter relaxes and >>the bladder contracts. Only the strong contraction of >>the bladder creates a powerful jet. If only the >>sphincter opened, it would be a long-lasting dribble. >>If you now - in whatever way - ensure that the >>sphincter always remains open, then you immediately >>achieve what is known as droplet incontinence. >>In principle you just have to stop the sphincter from >>closing. This can be achieved mechanically with a >>stent - this is a tube that always keeps the exit open >>- or with medication. Good old Botox has proven to be >>a good remedy. A few injections placed circularly into >>the sphincter ensure that once the medication has >>spread throughout the tissue, it weakens and no longer >>closes. After the injection, the full effect takes >>place within the next 12 hours. From then on, diapers >>are unavoidable for at least the next 12 weeks. >>It should be mentioned that the injections are very >>easy in girls, but are much more difficult in boys >>because of the much longer urethra and the associated >>poor access to the sphincter. But there are solutions >>here too. >> >>These comments may help some parents who are just >>starting out in diaper training when it comes to how >>to keep children in diapers for long periods of time.

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